|
IMPLT WEDGE EVANS 10X22X20MM
|
Facility
|
OP
|
$6,120.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006537
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,530.00 |
| Max. Negotiated Rate |
$5,814.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$3,672.00
|
| Rate for Payer: Cash Price |
$3,672.00
|
| Rate for Payer: Cash Price |
$3,672.00
|
| Rate for Payer: Cigna Commercial |
$5,202.00
|
| Rate for Payer: First Health Commercial |
$5,508.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,508.00
|
| Rate for Payer: GEHA Commercial |
$4,896.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,508.00
|
| Rate for Payer: Humana ChoiceCare |
$1,591.20
|
| Rate for Payer: Multiplan All |
$5,569.20
|
| Rate for Payer: New Mexico Health Connections Medicare |
$3,672.00
|
| Rate for Payer: OMNI Networks Commercial |
$4,284.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,508.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,814.00
|
| Rate for Payer: Three Rivers Provider Network All |
$4,590.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$5,385.60
|
| Rate for Payer: United Healthcare Managed Medicaid |
$1,530.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,691.60
|
| Rate for Payer: Zelis Auto |
$2,448.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$3,060.00
|
|
|
IMPLT WEDGE EVANS 10X22X20MM
|
Facility
|
IP
|
$6,120.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006537
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,448.00 |
| Max. Negotiated Rate |
$5,814.00 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$4,896.00
|
| Rate for Payer: Cash Price |
$3,672.00
|
| Rate for Payer: Cash Price |
$3,672.00
|
| Rate for Payer: Cigna Commercial |
$5,202.00
|
| Rate for Payer: First Health Commercial |
$5,508.00
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$5,508.00
|
| Rate for Payer: GEHA Commercial |
$4,284.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$5,508.00
|
| Rate for Payer: Multiplan All |
$5,569.20
|
| Rate for Payer: OMNI Networks Commercial |
$4,284.00
|
| Rate for Payer: One Health Plan PPO/POS |
$5,508.00
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$5,814.00
|
| Rate for Payer: Three Rivers Provider Network All |
$4,590.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$5,691.60
|
| Rate for Payer: Zelis Auto |
$2,448.00
|
|
|
IMPLT WEDGE OSTEO OSFERION 10X30MM
|
Facility
|
OP
|
$2,917.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$729.25 |
| Max. Negotiated Rate |
$2,771.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,750.20
|
| Rate for Payer: Cash Price |
$1,750.20
|
| Rate for Payer: Cash Price |
$1,750.20
|
| Rate for Payer: Cigna Commercial |
$2,479.45
|
| Rate for Payer: First Health Commercial |
$2,625.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,625.30
|
| Rate for Payer: GEHA Commercial |
$2,333.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,625.30
|
| Rate for Payer: Humana ChoiceCare |
$758.42
|
| Rate for Payer: Multiplan All |
$2,654.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,750.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,041.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,625.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,771.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,187.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,566.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$729.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,712.81
|
| Rate for Payer: Zelis Auto |
$1,166.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,458.50
|
|
|
IMPLT WEDGE OSTEO OSFERION 10X30MM
|
Facility
|
IP
|
$2,917.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7003036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,166.80 |
| Max. Negotiated Rate |
$2,771.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,333.60
|
| Rate for Payer: Cash Price |
$1,750.20
|
| Rate for Payer: Cash Price |
$1,750.20
|
| Rate for Payer: Cigna Commercial |
$2,479.45
|
| Rate for Payer: First Health Commercial |
$2,625.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,625.30
|
| Rate for Payer: GEHA Commercial |
$2,041.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,625.30
|
| Rate for Payer: Multiplan All |
$2,654.47
|
| Rate for Payer: OMNI Networks Commercial |
$2,041.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,625.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,771.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,187.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,712.81
|
| Rate for Payer: Zelis Auto |
$1,166.80
|
|
|
IMPLT WEDGE OSTEO OSFERION 12X35MM
|
Facility
|
IP
|
$2,917.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,166.80 |
| Max. Negotiated Rate |
$2,771.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,333.60
|
| Rate for Payer: Cash Price |
$1,750.20
|
| Rate for Payer: Cash Price |
$1,750.20
|
| Rate for Payer: Cigna Commercial |
$2,479.45
|
| Rate for Payer: First Health Commercial |
$2,625.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,625.30
|
| Rate for Payer: GEHA Commercial |
$2,041.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,625.30
|
| Rate for Payer: Multiplan All |
$2,654.47
|
| Rate for Payer: OMNI Networks Commercial |
$2,041.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,625.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,771.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,187.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,712.81
|
| Rate for Payer: Zelis Auto |
$1,166.80
|
|
|
IMPLT WEDGE OSTEO OSFERION 12X35MM
|
Facility
|
OP
|
$2,917.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006355
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$729.25 |
| Max. Negotiated Rate |
$2,771.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,750.20
|
| Rate for Payer: Cash Price |
$1,750.20
|
| Rate for Payer: Cash Price |
$1,750.20
|
| Rate for Payer: Cigna Commercial |
$2,479.45
|
| Rate for Payer: First Health Commercial |
$2,625.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,625.30
|
| Rate for Payer: GEHA Commercial |
$2,333.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,625.30
|
| Rate for Payer: Humana ChoiceCare |
$758.42
|
| Rate for Payer: Multiplan All |
$2,654.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,750.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,041.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,625.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,771.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,187.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,566.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$729.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,712.81
|
| Rate for Payer: Zelis Auto |
$1,166.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,458.50
|
|
|
IMPLT WEDGE OSTEOTOMY OSFERION 12X35MM
|
Facility
|
OP
|
$2,917.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006599
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$729.25 |
| Max. Negotiated Rate |
$2,771.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,750.20
|
| Rate for Payer: Cash Price |
$1,750.20
|
| Rate for Payer: Cash Price |
$1,750.20
|
| Rate for Payer: Cigna Commercial |
$2,479.45
|
| Rate for Payer: First Health Commercial |
$2,625.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,625.30
|
| Rate for Payer: GEHA Commercial |
$2,333.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,625.30
|
| Rate for Payer: Humana ChoiceCare |
$758.42
|
| Rate for Payer: Multiplan All |
$2,654.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,750.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,041.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,625.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,771.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,187.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,566.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$729.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,712.81
|
| Rate for Payer: Zelis Auto |
$1,166.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,458.50
|
|
|
IMPLT WEDGE OSTEOTOMY OSFERION 12X35MM
|
Facility
|
IP
|
$2,917.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7006599
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,166.80 |
| Max. Negotiated Rate |
$2,771.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,333.60
|
| Rate for Payer: Cash Price |
$1,750.20
|
| Rate for Payer: Cash Price |
$1,750.20
|
| Rate for Payer: Cigna Commercial |
$2,479.45
|
| Rate for Payer: First Health Commercial |
$2,625.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,625.30
|
| Rate for Payer: GEHA Commercial |
$2,041.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,625.30
|
| Rate for Payer: Multiplan All |
$2,654.47
|
| Rate for Payer: OMNI Networks Commercial |
$2,041.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,625.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,771.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,187.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,712.81
|
| Rate for Payer: Zelis Auto |
$1,166.80
|
|
|
IMPLT WEDGE OSTEOTOMY OSFERION 7X12MM
|
Facility
|
OP
|
$2,917.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002325
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$729.25 |
| Max. Negotiated Rate |
$2,771.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$1,750.20
|
| Rate for Payer: Cash Price |
$1,750.20
|
| Rate for Payer: Cash Price |
$1,750.20
|
| Rate for Payer: Cigna Commercial |
$2,479.45
|
| Rate for Payer: First Health Commercial |
$2,625.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,625.30
|
| Rate for Payer: GEHA Commercial |
$2,333.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,625.30
|
| Rate for Payer: Humana ChoiceCare |
$758.42
|
| Rate for Payer: Multiplan All |
$2,654.47
|
| Rate for Payer: New Mexico Health Connections Medicare |
$1,750.20
|
| Rate for Payer: OMNI Networks Commercial |
$2,041.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,625.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,771.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,187.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$2,566.96
|
| Rate for Payer: United Healthcare Managed Medicaid |
$729.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,712.81
|
| Rate for Payer: Zelis Auto |
$1,166.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$1,458.50
|
|
|
IMPLT WEDGE OSTEOTOMY OSFERION 7X12MM
|
Facility
|
IP
|
$2,917.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
7002325
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,166.80 |
| Max. Negotiated Rate |
$2,771.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$2,333.60
|
| Rate for Payer: Cash Price |
$1,750.20
|
| Rate for Payer: Cash Price |
$1,750.20
|
| Rate for Payer: Cigna Commercial |
$2,479.45
|
| Rate for Payer: First Health Commercial |
$2,625.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$2,625.30
|
| Rate for Payer: GEHA Commercial |
$2,041.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$2,625.30
|
| Rate for Payer: Multiplan All |
$2,654.47
|
| Rate for Payer: OMNI Networks Commercial |
$2,041.90
|
| Rate for Payer: One Health Plan PPO/POS |
$2,625.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$2,771.15
|
| Rate for Payer: Three Rivers Provider Network All |
$2,187.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$2,712.81
|
| Rate for Payer: Zelis Auto |
$1,166.80
|
|
|
IMPLT WIRE 1.25X280MM CERCLAGE
|
Facility
|
OP
|
$658.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$625.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$394.80
|
| Rate for Payer: Cash Price |
$394.80
|
| Rate for Payer: Cash Price |
$394.80
|
| Rate for Payer: Cigna Commercial |
$559.30
|
| Rate for Payer: First Health Commercial |
$592.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$592.20
|
| Rate for Payer: GEHA Commercial |
$526.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$592.20
|
| Rate for Payer: Humana ChoiceCare |
$171.08
|
| Rate for Payer: Multiplan All |
$598.78
|
| Rate for Payer: New Mexico Health Connections Medicare |
$394.80
|
| Rate for Payer: OMNI Networks Commercial |
$460.60
|
| Rate for Payer: One Health Plan PPO/POS |
$592.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$625.10
|
| Rate for Payer: Three Rivers Provider Network All |
$493.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$579.04
|
| Rate for Payer: United Healthcare Managed Medicaid |
$164.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$611.94
|
| Rate for Payer: Zelis Auto |
$263.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$329.00
|
|
|
IMPLT WIRE 1.25X280MM CERCLAGE
|
Facility
|
IP
|
$658.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7003431
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.20 |
| Max. Negotiated Rate |
$625.10 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$526.40
|
| Rate for Payer: Cash Price |
$394.80
|
| Rate for Payer: Cash Price |
$394.80
|
| Rate for Payer: Cigna Commercial |
$559.30
|
| Rate for Payer: First Health Commercial |
$592.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$592.20
|
| Rate for Payer: GEHA Commercial |
$460.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$592.20
|
| Rate for Payer: Multiplan All |
$598.78
|
| Rate for Payer: OMNI Networks Commercial |
$460.60
|
| Rate for Payer: One Health Plan PPO/POS |
$592.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$625.10
|
| Rate for Payer: Three Rivers Provider Network All |
$493.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$611.94
|
| Rate for Payer: Zelis Auto |
$263.20
|
|
|
IMPLT WIRE 1.5X280MM CERCLAGE
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$89.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$79.90
|
| Rate for Payer: First Health Commercial |
$84.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$84.60
|
| Rate for Payer: GEHA Commercial |
$75.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$84.60
|
| Rate for Payer: Humana ChoiceCare |
$24.44
|
| Rate for Payer: Multiplan All |
$85.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$56.40
|
| Rate for Payer: OMNI Networks Commercial |
$65.80
|
| Rate for Payer: One Health Plan PPO/POS |
$84.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$89.30
|
| Rate for Payer: Three Rivers Provider Network All |
$70.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$82.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$87.42
|
| Rate for Payer: Zelis Auto |
$37.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$47.00
|
|
|
IMPLT WIRE 1.5X280MM CERCLAGE
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.60 |
| Max. Negotiated Rate |
$89.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$75.20
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$79.90
|
| Rate for Payer: First Health Commercial |
$84.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$84.60
|
| Rate for Payer: GEHA Commercial |
$65.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$84.60
|
| Rate for Payer: Multiplan All |
$85.54
|
| Rate for Payer: OMNI Networks Commercial |
$65.80
|
| Rate for Payer: One Health Plan PPO/POS |
$84.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$89.30
|
| Rate for Payer: Three Rivers Provider Network All |
$70.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$87.42
|
| Rate for Payer: Zelis Auto |
$37.60
|
|
|
IMPLT WIRE .8X280MM CERCLAGE
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002895
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.60 |
| Max. Negotiated Rate |
$89.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$75.20
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$79.90
|
| Rate for Payer: First Health Commercial |
$84.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$84.60
|
| Rate for Payer: GEHA Commercial |
$65.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$84.60
|
| Rate for Payer: Multiplan All |
$85.54
|
| Rate for Payer: OMNI Networks Commercial |
$65.80
|
| Rate for Payer: One Health Plan PPO/POS |
$84.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$89.30
|
| Rate for Payer: Three Rivers Provider Network All |
$70.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$87.42
|
| Rate for Payer: Zelis Auto |
$37.60
|
|
|
IMPLT WIRE .8X280MM CERCLAGE
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002895
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$89.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$79.90
|
| Rate for Payer: First Health Commercial |
$84.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$84.60
|
| Rate for Payer: GEHA Commercial |
$75.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$84.60
|
| Rate for Payer: Humana ChoiceCare |
$24.44
|
| Rate for Payer: Multiplan All |
$85.54
|
| Rate for Payer: New Mexico Health Connections Medicare |
$56.40
|
| Rate for Payer: OMNI Networks Commercial |
$65.80
|
| Rate for Payer: One Health Plan PPO/POS |
$84.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$89.30
|
| Rate for Payer: Three Rivers Provider Network All |
$70.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$82.72
|
| Rate for Payer: United Healthcare Managed Medicaid |
$23.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$87.42
|
| Rate for Payer: Zelis Auto |
$37.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$47.00
|
|
|
IMPLT WIRE FX100MM 1.2MM KRSH ASNS
|
Facility
|
OP
|
$548.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$137.00 |
| Max. Negotiated Rate |
$520.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$328.80
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cigna Commercial |
$465.80
|
| Rate for Payer: First Health Commercial |
$493.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$493.20
|
| Rate for Payer: GEHA Commercial |
$438.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$493.20
|
| Rate for Payer: Humana ChoiceCare |
$142.48
|
| Rate for Payer: Multiplan All |
$498.68
|
| Rate for Payer: New Mexico Health Connections Medicare |
$328.80
|
| Rate for Payer: OMNI Networks Commercial |
$383.60
|
| Rate for Payer: One Health Plan PPO/POS |
$493.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$520.60
|
| Rate for Payer: Three Rivers Provider Network All |
$411.00
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$482.24
|
| Rate for Payer: United Healthcare Managed Medicaid |
$137.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$509.64
|
| Rate for Payer: Zelis Auto |
$219.20
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$274.00
|
|
|
IMPLT WIRE FX100MM 1.2MM KRSH ASNS
|
Facility
|
IP
|
$548.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
7002750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$219.20 |
| Max. Negotiated Rate |
$520.60 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$438.40
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cigna Commercial |
$465.80
|
| Rate for Payer: First Health Commercial |
$493.20
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$493.20
|
| Rate for Payer: GEHA Commercial |
$383.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$493.20
|
| Rate for Payer: Multiplan All |
$498.68
|
| Rate for Payer: OMNI Networks Commercial |
$383.60
|
| Rate for Payer: One Health Plan PPO/POS |
$493.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$520.60
|
| Rate for Payer: Three Rivers Provider Network All |
$411.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$509.64
|
| Rate for Payer: Zelis Auto |
$219.20
|
|
|
IMPLT WIRE GLIDE ZIPWIRE.025
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.80 |
| Max. Negotiated Rate |
$320.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$269.60
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cigna Commercial |
$286.45
|
| Rate for Payer: First Health Commercial |
$303.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$303.30
|
| Rate for Payer: GEHA Commercial |
$235.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$303.30
|
| Rate for Payer: Multiplan All |
$306.67
|
| Rate for Payer: OMNI Networks Commercial |
$235.90
|
| Rate for Payer: One Health Plan PPO/POS |
$303.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$320.15
|
| Rate for Payer: Three Rivers Provider Network All |
$252.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$313.41
|
| Rate for Payer: Zelis Auto |
$134.80
|
|
|
IMPLT WIRE GLIDE ZIPWIRE.025
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.25 |
| Max. Negotiated Rate |
$320.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$202.20
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cigna Commercial |
$286.45
|
| Rate for Payer: First Health Commercial |
$303.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$303.30
|
| Rate for Payer: GEHA Commercial |
$269.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$303.30
|
| Rate for Payer: Humana ChoiceCare |
$87.62
|
| Rate for Payer: Multiplan All |
$306.67
|
| Rate for Payer: New Mexico Health Connections Medicare |
$202.20
|
| Rate for Payer: OMNI Networks Commercial |
$235.90
|
| Rate for Payer: One Health Plan PPO/POS |
$303.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$320.15
|
| Rate for Payer: Three Rivers Provider Network All |
$252.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$296.56
|
| Rate for Payer: United Healthcare Managed Medicaid |
$84.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$313.41
|
| Rate for Payer: Zelis Auto |
$134.80
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$168.50
|
|
|
IMPLT WIRE GUIDE .035MM X 6IN.
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$166.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$148.75
|
| Rate for Payer: First Health Commercial |
$157.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$157.50
|
| Rate for Payer: GEHA Commercial |
$140.00
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$157.50
|
| Rate for Payer: Humana ChoiceCare |
$45.50
|
| Rate for Payer: Multiplan All |
$159.25
|
| Rate for Payer: New Mexico Health Connections Medicare |
$105.00
|
| Rate for Payer: OMNI Networks Commercial |
$122.50
|
| Rate for Payer: One Health Plan PPO/POS |
$157.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$166.25
|
| Rate for Payer: Three Rivers Provider Network All |
$131.25
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$154.00
|
| Rate for Payer: United Healthcare Managed Medicaid |
$43.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$162.75
|
| Rate for Payer: Zelis Auto |
$70.00
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$87.50
|
|
|
IMPLT WIRE GUIDE .035MM X 6IN.
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$166.25 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$140.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$148.75
|
| Rate for Payer: First Health Commercial |
$157.50
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$157.50
|
| Rate for Payer: GEHA Commercial |
$122.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$157.50
|
| Rate for Payer: Multiplan All |
$159.25
|
| Rate for Payer: OMNI Networks Commercial |
$122.50
|
| Rate for Payer: One Health Plan PPO/POS |
$157.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$166.25
|
| Rate for Payer: Three Rivers Provider Network All |
$131.25
|
| Rate for Payer: United Payors & United Providers UP&UP |
$162.75
|
| Rate for Payer: Zelis Auto |
$70.00
|
|
|
IMPLT WIRE GUIDE.035X145 FIXED CORE
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$127.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$107.20
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$113.90
|
| Rate for Payer: First Health Commercial |
$120.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$120.60
|
| Rate for Payer: GEHA Commercial |
$93.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$120.60
|
| Rate for Payer: Multiplan All |
$121.94
|
| Rate for Payer: OMNI Networks Commercial |
$93.80
|
| Rate for Payer: One Health Plan PPO/POS |
$120.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$127.30
|
| Rate for Payer: Three Rivers Provider Network All |
$100.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$124.62
|
| Rate for Payer: Zelis Auto |
$53.60
|
|
|
IMPLT WIRE GUIDE.035X145 FIXED CORE
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33.50 |
| Max. Negotiated Rate |
$127.30 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$113.90
|
| Rate for Payer: First Health Commercial |
$120.60
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$120.60
|
| Rate for Payer: GEHA Commercial |
$107.20
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$120.60
|
| Rate for Payer: Humana ChoiceCare |
$34.84
|
| Rate for Payer: Multiplan All |
$121.94
|
| Rate for Payer: New Mexico Health Connections Medicare |
$80.40
|
| Rate for Payer: OMNI Networks Commercial |
$93.80
|
| Rate for Payer: One Health Plan PPO/POS |
$120.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$127.30
|
| Rate for Payer: Three Rivers Provider Network All |
$100.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$117.92
|
| Rate for Payer: United Healthcare Managed Medicaid |
$33.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$124.62
|
| Rate for Payer: Zelis Auto |
$53.60
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$67.00
|
|
|
IMPLT WIRE GUIDE .045MM X 6IN
|
Facility
|
IP
|
$797.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
7001748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$318.80 |
| Max. Negotiated Rate |
$757.15 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$637.60
|
| Rate for Payer: Cash Price |
$478.20
|
| Rate for Payer: Cash Price |
$478.20
|
| Rate for Payer: Cigna Commercial |
$677.45
|
| Rate for Payer: First Health Commercial |
$717.30
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$717.30
|
| Rate for Payer: GEHA Commercial |
$557.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$717.30
|
| Rate for Payer: Multiplan All |
$725.27
|
| Rate for Payer: OMNI Networks Commercial |
$557.90
|
| Rate for Payer: One Health Plan PPO/POS |
$717.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$757.15
|
| Rate for Payer: Three Rivers Provider Network All |
$597.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$741.21
|
| Rate for Payer: Zelis Auto |
$318.80
|
|
